• Thảo Mac

Psychiatry in the Middle East

Nowadays, many people think of the Middle East as a war-ridden region, where the sound of bomb strikes and children’s cries echo across the land. But once upon a time, the Middle East was the leading region of civilization and medical innovation, especially mental health provisions.

The Middle East is a term that describes a large territory that spans from Northern India, across Turkey, and down to Northern African countries like Egypt, Libya, Morocco, and Tunisia. Not only does the vast territory enable the trade of goods, but also cultures and knowledge. Thus, during the Medieval era, the Middle East’s civilization was far more advanced compared to many other regions of the world. One of their most innovative fields at the time was medicine.

After the fall of Ancient Greece, their medical studies were adopted by Arabic kingdoms. The Arabic took the science of Humorism, founded by Hippocrates, and adapted it to reflect their religious belief. The result was a benevolent approach to illness, especially to mental disorders. Back then, in the Middle East, people who suffered from mental illness were believed to be disturbed by ghosts or spirits, who spoiled the patient’s inner peace. To restore their inner peace, i.e. to cure the mental disorder, doctors applied remedies such as rest, diet, bath, and music. While the result of such remedies was vague, we can be certain that this treatment was one of the most compassionate approaches to mental illness in history.

The earliest form of a hospital – also known as bimaristan – appeared around the ninth century in Baghdad. It became the model for other hospitals that were later built in the region. Whether they suffered from bodily wounds or mental disorders, all patients were housed in the same “bimaristan”. After the publication of “Canon of Medicine” written by Avicenna in 1025, libraries became an essential part of Arabic hospitals. Additionally, doctors, also known as “hakim” – the wise men, not only mastered the art of medicine but were also required to learn arts and crafts, such as astrology and music. A modern doctor will argue about the necessity of such practice, but in a world where recreational music sessions were supported by medical treatments, such requirements were sensible. This was allegedly the golden era of medical innovations in the Middle East and the world.


Around the thirteenth century, the glory of medical studies in the Middle East started to subside. The Mongol invasion, which occurred in 1220, destroyed cities and massacred millions of people. It undid centuries of achievements in the Middle East. Afterward, the Ottoman Empire – one of the largest and most powerful Middle Eastern empires at the time – started to dwindle. For several centuries, no revolutionary mental health innovation was developed out of any of the Islamic territories.


Fast forward a couple of centuries later, colonialism overtook the Middle East. European colonizers brought their ideas of modern medicine with them and built the first modern European-standard lunatic asylum in the nineteenth century. Soon, asylums sprouted up all over the region. From this point onward, the mental health provisions of the Islamic countries merged with that of the West. Psychiatry hospitals continued to grow in both size and number throughout the years. Even when deinstitutionalization hit the West in the middle of the twentieth century and tore down old madhouses such as Bedlam and Blackwell, the number of psychiatry hospitals in the Middle East continued rising.


Today, the number of psychiatry beds in the Middle East far exceeds that in many other parts of the world. It is also the region with the biggest psychiatry hospitals in the world. For example, the Abbasiya mental hospital in Egypt has about 1500 psychiatry beds. Al-Rashad Mental Hospital in Baghdad currently has more than 1300. However, quantity does not mean quality. In 2019, a worker at Al-Fanar – a psychiatric hospital in Lebanon – exposed the inhumane conditions that the patients there were suffering with. The conditions were comparable to old, barbaric madhouses back in the nineteenth century in the West. A recent 2020 study published by Cambridge University Press supported the exposure of Al-Fanar. The true situation of Middle Eastern psychiatry is a bleak picture that is not too different from that of the old Western institutionalization. Patients are neglected and kept in cells like prisoners; hospitals are overcrowded and underfunded. The only exceptions in the region are Israel, Turkey, and Iran, where the mental health provisions are comparable to Western countries like the USA.


The reason for the neglect of mental health in many Middle Eastern countries is possibly due to their political situation. For centuries, this region has been through colonialism, civil wars, religious wars, and terrorism. Just like the Mogul invasion, the constant wars hinder the development of psychiatry in the area. To revolutionize the state of mental health treatments in the Middle East, we need to get rid of the stigma against mental illness and allow these countries time to heal from the wounds of wars.

 

Speaking Plainly:

  • In Medieval times, the Arabs treated mentally ill people with recreational activities like rest and music.

  • From the ninth to the fourteenth century, the Middle East was a hotbed of medical innovations.

  • The Mongol invasion in the thirteenth century started the decline of medical advancement in the area.

  • The first Western-standard psychiatry hospitals were built in the nineteenth century, but the conditions are similar to that of old Western institutionalization

  • The number of mental asylums in the Middle East far exceeds that in the West, due to the lack of deinstitutionalization.